Why physicians should support, not oppose, ICD-10

New evidence suggests physicians will see a positive financial change from the conversion and that individual patients will benefit.

The American Medical Association and many of its members have opposed implementation of ICD-10 because of the costs associated with the conversion. The AMA and many state medical associations have urged their members to send letters to legislators that include this sentence: The ICD-10 mandate is a huge burden for my practice with absolutely no direct benefit to individual patient care.”

But there is new evidence that physicians will see a positive financial change from the conversion and that individual patients will benefit.

Enhancing the bottom line

Let’s look first at the “huge burden” of conversion. According to a recent article published by the American Health Information Management Association (AHIMA), “new data suggests that the estimated costs, time, and resources required by physician offices are dramatically lower than initially estimated as a result of readily available free and low cost solutions offered by coding education and software vendors. The revised estimated costs for ICD-10 for a small practice to be prepared for the conversion to ICD-10 is in the range of $1,960-$5,900, where a small practice is defined as three physicians and two impacted staff such as coders and/or front desk/back office personnel. A widely referenced 2008 report by Nachimson Advisors to the American Medical Association estimated the cost for a small practice to implement ICD-10 was in the range of $22,560 to $105,506, which is substantially higher than the $1,960 to $5,900 estimated in this article.”

This older, exaggerated estimate of the cost burden has stoked physician fears and blinded them to a very real and positive aspect of the conversion: increased revenue.

While it is true that a physician’s practice can’t increase its fees to cover conversion costs (as the AMA letter says), physician practices and health systems that have trained physicians and clinical staff to use more granular and complete documentation to meet ICD-10 requirements have experienced increased reimbursements, even while using ICD-9 codes. The less stringent documentation practiced under ICD-9 often results in under-coding of more complex patient care, and the documentation required by ICD-10 allows for more accurate – and higher – coding. These organizations expect the more specific ICD-10 codes to further reduce the number of under-coded claims.

So the “huge burden” turns out to be pretty small and will be offset by increased reimbursement for complex care.

Now let’s look at the effects of conversion on individual patients. It’s true that if you look at healthcare as an isolated episode of care ICD-10 doesn’t offer any real advantage. But healthcare isn’t a series of isolated events; it’s a continuum. Care, for individuals and for populations, gets better over time as more knowledge is gained. The path to that knowledge is data. The better data we have, the better we can design care to improve population health and the better we can fit care to the needs of individuals. ICD-9 is woefully lacking in its ability to provide the data needed to improve the both individual and population health.

A few years back, a representative of the CDC explained to members at a HIMSS event that they could more accurately track outbreaks of influenza by tracking Google search information than they could by tracking information provided by healthcare systems through electronic submissions using ICD-9 codes. With this year’s Ebola outbreak, you may be alarmed to know that there is no way to track Ebola with ICD-9 codes as there is no code for Ebola. In ICD-10, there are specific Ebola codes.

Most other countries in the world have switched to ICD-10 because it provides better information to better care for their populations.

The delay hurts physicians financially

The U.S. Department of Health and Human Services (HHS) estimated that the cost of transitioning from ICD-9 diagnosis and medical procedure codes to ICD-10 codes would be $1.64 billion ($357 million for staff training, $572 million for losses in productivity, and $713 for system changes).

Healthcare organizations that were prepared for a 2013 conversion deadline have already incurred most of the costs for training and system changes, and they must continue to spend more on training during the delay to ensure skills gained don’t disappear through disuse. Various industry experts have estimated that the delay will cost these organizations between $1 billion and $6 billion. This is a combination of additional training costs, loss of the increased revenue for complex care and delay of savings that HHS estimates will be more than $87.7 million annually—and as much as $3.95 billion by 2023.

Many of these organizations are larger physician practices. So delaying the conversion not only hurts hospitals and health systems, it hurts many of the AMA’s members.

For those physicians who haven’t prepared for conversion, delaying doesn’t avoid the associated costs; it just pushes those costs into the future. But it also pushes out the ability to receive higher reimbursement for complex care – and that is revenue that can never be reclaimed.

Sharing knowledge is the core reason for conversion

In deciding whether to support or oppose ICD-10 implementation, the AMA and individual physicians might look for guidance from one modern version of the Hippocratic Oath, written in 1964 by Louis Lasagna, academic dean of the School of Medicine at Tufts University:

“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

ICD-10 provides a vehicle for increasing and sharing knowledge that will benefit both physicians and the patients they serve.

Credible, Defensible EstimatesIn healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

Clinical Quality Measures 101Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report ...

Care Collaboration Success for Improved OutcomesThe nature of our healthcare ecosystem has been one of siloed care. Rarely do payers, providers and local resources come together with the patient's well-being prioritized as a unifying mission. Read how these organizations are getting it right.

Debunk the Myth: Outsourcing Doesn't Mean Losing ControlWith shifts in payer mixes and reimbursement structure, the margin of reimbursement has been shrinking steadily over the last five years. How do revenue cycle leaders navigate payment reform while maintaining stable business office operations?

Credible, Defensible EstimatesIn healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

Clinical Quality Measures 101Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report ...